Small Animal Regional Anesthesia and Analgesia

Small Animal Regional Anesthesia and Analgesia

Dedication To my dearest wife Ewa for being the most understanding and supportive person in the whole wide world and to my children Kyla and Kian who I love to bits. Luis Campoy To my wife, Emma, and my children Grace and Kate for their support and encouragement. There were many days and nights spent working on this book and without their understanding, this project would not have been possible. I also extend my gratitude to Ban Tsui, MD and Vincent Chan, MD for opening the world of regional anesthesia to me and for sharing their enthusiasm for this wonderful specialty. Finally, I would like to thank my partner in this project, Luis Campoy, for his friendship and tireless efforts in getting this book to publication. Cheers! Matt Read

Small Animal Regional Anesthesia and Analgesia Editors Luis Campoy, LV CertVA, DipECVAA, MRCVS Senior Lecturer in Anesthesiology Section of Anesthesiology and Analgesia Department of Clinical Sciences College of Veterinary Medicine Cornell University Ithaca, NY, USA Matt R. Read, DVM, MVSc, DACVA Associate Professor Department of Comparative Biology and Experimental Medicine Faculty of Veterinary Medicine University of Calgary Calgary, AB, Canada A John Wiley & Sons, Inc., Publication

This edition first published 2013 2013 by ISUP, a division of John Wiley & Sons, Inc Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley s global Scientific, Technical and Medical business with Blackwell Publishing. Editorial Offices 2121 State Avenue, Ames, Iowa 50014-8300, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Blackwell Publishing, provided that the base fee is paid directly to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payments has been arranged. The fee codes for users of the Transactional Reporting Service are ISBN-13: 978-0-8138-1994-5/2013. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging-in-Publication Data Small animal regional anesthesia and analgesia / editors, Luis Campoy, Matt R. Read. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8138-1994-5 (hardback : alk. paper) I. Campoy, Luis, MRCVS. II. Read, Matt R. [DNLM: 1. Anesthesia, Conduction veterinary. 2. Analgesia methods. 3. Analgesia veterinary. 4. Anesthesia, Conduction methods. 5. Cats surgery. 6. Dogs surgery. SF 914] 2012028811 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover design by Jen Miller Designs Set in 9.5/11.5pt Palatino by SPi Publisher Services, Pondicherry, India 1 2013

Contents Contributors Foreword Preface Acknowledgments vii ix xi xiii Part 1 Considerations for Loco-regional Anesthesia 1 1 History of Regional Anesthesia 3 Kristopher Schroeder 2 General Considerations 11 Luis Campoy and Kristopher Schroeder 3 Patient Preparation 19 Luis Campoy and Matt R. Read 4 Clinical Pharmacology and Toxicology of Local Anesthetics and Adjuncts 25 Manuel Martin-Flores Part 2 Equipment 41 5 Equipment for Loco-regional Anesthesia and Analgesia 43 Matt R. Read 6 Peripheral Nerve Stimulators 65 Robert M. Raw, Matt R. Read, and Luis Campoy 7 Ultrasound-guided Peripheral Nerve Blocks 77 Olga Seco, Laura Zarucco, and Luis Campoy Part 3 Loco-regional Anesthetic Blocks for Small Animal Patients 87 8 Incisional Infiltration of Local Anesthetics and Use of Wound Catheters 89 Matt R. Read 9 The Eye 103 Elizabeth A. Giuliano and Karen P. Walsh 10 The Oral Cavity 119 Margherita Gracis 11 The Thoracic Limb 141 Luis Campoy and Matt R. Read 12 The Trunk 167 Matt R. Read and Carrie A. Schroeder v

vi Contents 13 The Pelvic Limb 199 Luis Campoy and Stephan Mahler 14 Epidural and Spinal Anesthesia 227 Pablo E. Otero and Luis Campoy 15 Intravenous Regional Anesthesia 261 Francesco Staffieri Index 273

Contributors Luis Campoy, LV CertVA, DipECVAA, MRCVS Senior Lecturer in Anesthesiology Section of Anesthesiology and Analgesia Department of Clinical Sciences College of Veterinary Medicine Cornell University Ithaca, NY, USA Elizabeth A. Giuliano, DVM, MS, DACVO Associate Professor College of Veterinary Medicine University of Missouri Columbia, MO, USA Margherita Gracis, Med Vet, Dipl. AVDC, Dipl. EVDC Clinica Veterinaria San Siro Milano, Italy Stephan Mahler, DVM, MA, MSc, PhD Clinique Vétérinaire Pans Bêtes Acigné, France Manuel Martin-Flores, MV, DACVA Assistant Professor of Anesthesiology Department of Clinical Sciences College of Veterinary Medicine Cornell University Ithaca, NY, USA Pablo E. Otero DVM, PhD Head, Division of Anaesthesiology and Pain Management College of Veterinary Medicine Buenos Aires University Ciudad Autónoma de Buenos Aires, Argentina Robert M. Raw, MbChB, MPraxMed, MFGP, DA, FCA Associate Professor, Anesthesia University of Iowa Iowa City, IO, USA Matt R. Read, DVM, MVSc, DACVA Associate Professor Department of Comparative Biology and Experimental Medicine Faculty of Veterinary Medicine University of Calgary Calgary, AB, Canada Carrie A. Schroeder, DVM, DACVA Adjunct Clinical Instructor-Anesthesia and Pain Management School of Veterinary Medicine University of Wisconsin Madison, WI, USA vii

viii Contributors Kristopher Schroeder, MD Assistant Professor Department of Anesthesiology School of Medicine and Public Health University of Wisconsin Madison, WI, USA Olga Seco, Licenciada en Veterinaria, MRCVS Adjunct Assistant Professor Sports Medicine and Imaging, Clinical Studies New Bolton Center School of Veterinary Medicine University of Pennsylvania Kennett Square, PA, USA Francesco Staffieri, DVM, PhD Assistant Professor in Veterinary Anesthesia D.E.O.T. Section of Veterinary Surgery Faculty of Veterinary Medicine University of Bari Aldo Moro Bari, Italy Karen P. Walsh BVetMed, DVA, MRCVS, DECVAA European Specialist in Veterinary Anaesthesia and Analgesia Willows Veterinary Centre Highlands Road Shirley West Midlands, UK Laura Zarucco, DMV, PhD Associate Professor of Surgery Department of Animal Pathology Section of Surgery, Universita degli Studi di Torino Facolta di Medicina Veterinaria Turin, Italy

Foreword I am a medical anesthesiologist. My first meeting with veterinary anesthesiology was in 1997. A pet falcon belonging to a medical anesthesiologist friend needed an anesthetic for the fitting of a radio transmitter. The veterinarian who did the anesthetic was Dr. Lynette Bester. The falcon- owning friend next introduced Dr. Bester to me and we began an enduring scientific liaison of lecturing and teaching at scientific meetings we respectively organized. We developed an anesthetized pig workshop as a tool for teaching regional anesthesia techniques to both medical and veterinary anesthesiologists in South Africa. In 2003 Dr. Bester and I were invited to present a regional anesthesia course in Knoxville Tennessee at the World Congress of Veterinary Anesthesiology. Attending that WCVA-2003 regional anesthesia course were Drs. Luis Campoy and Matt Read, both of whom I met for the first time. Luis and Matt have told me that the Knoxville WCVA regional anesthesia course was a milestone in their growing passion for regional anesthesia. Subsequently Luis and I jointly organized a veterinary regional anesthesia skills course in Iowa and we lectured together at the regional anesthesia meetings of ISVRA in Italy. It seems a few blinks later Luis and Matt were producing this book and honoring me with an invitation to contribute a chapter and write this foreword. There is a warm story of professional bonds between all of this book s authors and their passion for their work and for regional anesthesia. I hope this book transmits that passion onto the readers. There are many good reasons to perform regional anesthesia on our patients, both medical and veterinary. The primary outcome is postsurgical analgesia. This reduces patient suffering and facilitates faster return to normal eating, earlier mobilization, and swifter general recovery, which are in turn additional secondary outcome benefits. There are, however, many more secondary outcome benefits. In human studies, evidence strongly suggests that regional anesthesia diminishes chronic pain syndromes, diminishes cancer recurrences, reduces surgical infection, and reduces cardiovascular and pulmonary complications. The addition of regional anesthesia to a general anesthetic also allows significant anesthetic drug dose reduction. Reduced general anesthetic drug doses allow faster patient recovery from the general anesthetic. General anesthesia may seem to be a nontherapeutic specialty that only exists to make surgery possible. Regional anesthesia is different, however, as it offers significant benefits that endure after the surgery. The first book in medicine devoted solely to regional anesthesia was published in 1917 by Victor Pauchet. Gaston Labat translated Pauchet s book into English in 1924. A generation later in ix

x Foreword 1953, Daniel Moore took the science further with his legendary book titled Regional Block. Moore s book was continually reprinted for another generation of anesthesiologists. The use of ultrasound guidance for peripheral nerve block needle placement became popular after 2005 and this hugely accelerated medical regional anesthesia s growth in popularity. Veterinary regional anesthesia s development is running parallel to medical regional anesthesia development. The two biggest limiting factors in regional anesthesia are lack of technical skill among practitioners and ignorance of surgeons on the risks and benefits. Education is the solution to both. This book will greatly help with that. The growth in public sentiment and concern for the suffering of animals will also drive the popularity of regional anesthesia as a form of pain control for small animals with injuries and postsurgical pain. Every reason that exists to promote the use of regional anesthesia in humans is as valid to promote the use of regional anesthesia in animals. Apart from being the historic book it is, I am sure this book by Drs. Campoy and Read will also long remain a definitive text book on veterinary regional anesthesia. The science of veterinary regional anesthesia will accelerate from now forward as much medical regional anesthesia did after the publication of each book by Pauchet, Labat, and Moore. The honor of publishing the first veterinary regional anesthesia book will always belong to editors Campoy and Read and their writing team. Robert M. Raw, MD Professor of Anesthesia University of Iowa Iowa City, Iowa, USA

Preface Small Animal Regional Anesthesia and Analgesia was written with a wide audience in mind. For many years, local and regional anesthesia in animals was considered to be an art, with techniques that were developed decades ago still being used without any particular attention being made to advancing the science behind the different procedures. Over the last 10 years, rapid advances in human regional anesthesia have started to carry over into veterinary medicine. Recently, many studies have been conducted in small animals to document, describe, and improve local and regional anesthetic blocks in our small animal patients. The primary goal of this text is to put a large body of information in one place for the first time. Interest in regional anesthesia in animals is not limited to one particular geographic area; as a result, we have invited an international group of authors to share their experience and expertise with us. This text will hopefully have something for everyone it can be used as a text with complete reference lists and extensive discussion of different topics, or as a quick source of information with procedural checklists, pictures, and diagrams to assist with performance of the various blocks. Our hope is this book will serve as the impetus to standardize the various procedures that are used clinically (so we are all speaking the same language when we talk about these blocks), and will stimulate continued interest in this particular subspecialty of anesthesia and pain management in veterinary medicine. Although our understanding of regional anesthesia in small animals still has a long way to go, we are on the cusp of some exciting new developments that will undoubtedly contribute to better outcomes and improved patient care. Luis Campoy and Matt Read xi

Acknowledgments We would like to acknowledge the contributions of our coauthors, all of whom had great enthusiasm for seeing this project come to fruition. The energy and time that they poured into this book is easy to see. We also want to thank the team at Wiley, who provided us with support and mentoring through the entire process. We would like to especially thank Ms. Erica Judisch, commissioning editor at Wiley, for her tireless assistance, patience, and understanding. Without her, this book would never have been completed. We are also grateful for the help of Ms. Susan Engelken and Ms. Carrie Horn at Wiley, Ms. Eilidh McGregor for copyediting, Mr. Pascal Raj Francois for production, and the proofreaders and indexers who helped in the final stages. Finally, we would like to acknowledge our colleague, Dr. Bernd Driessen, for initially bringing us together on this exciting project. xiii